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Impressive Gains in Children’s Health Insurance Coverage;
Many children remain uninsuredGains may be threatened by proposed caps to public programs

LOS ANGELES –Nearly nine in ten Los Angeles County children (ages 0-17 years) have some form of health insurance coverage (89.7%), according to a report just released by the Los Angeles County Department of Health Services. New findings from the 2002-03 Los Angeles County Health Survey show that since 1997, there has been a 45% decrease in the rate of uninsured and a 40% increase in the rate of children covered by Medi-Cal and Healthy Families—public coverage for low-income children. However, the rate of children covered by private health insurance, primarily employer-based coverage, has remained largely unchanged since 1997, suggesting a reversal from the modest gains in employer-based coverage observed in 1999.

Although the number of insured children has increased, 276,000 children remain uninsured. Furthermore, inequities persist, with Latino children nearly four times, and Asian/Pacific Islander children nearly three times as likely to be uninsured compared to white and African- American children.

“We are pleased with the upward trend in health insurance coverage among children, but further progress towards universal insurance coverage is needed,” said Jonathan Fielding, M.D., M.P.H., Director of Public Health and County Health Officer. “We are concerned that these gains will be jeopardized by the state’s fiscal crisis and resulting proposed changes to public insurance programs in the Governor’s budget.”

Since the growth in coverage has been in Medi-Cal and Healthy Families rather than private coverage, proposed budget cuts threaten the significant progress in coverage rates. For example, the Legislative Analyst’s Office budget analysis estimated that the proposed Healthy Families cap would result in 159,000 children on the waiting list by the end of 2004-05, with waits as long as six months.

In Los Angeles County, the percentage uninsured was higher among children aged 6 to 17 years (12%) than those five years of age and younger (6%). The percentage uninsured was also higher among Latino (14%) and Asian/Pacific Islander (10%) children than among white (4%) and African-American (3%) children. In addition 17% of children living in households with incomes below the federal poverty level (FPL) were uninsured compared to only 1% among those with incomes above 300% FPL.

Findings from the survey also revealed that uninsured children were more than four times as likely not to have a regular source of health care than children covered by private and other forms of public insurance (e.g., Medi-Cal or Healthy Families). Furthermore, parents of uninsured children were more than three times as likely to report difficulty obtaining needed medical care for their child in the past 12 months compared to parents of children with private and other forms of public insurance. “Children lacking health insurance are less likely to receive needed health care services,” said Paul Simon, M.D., M.P.H., Director of the Health Assessment and Epidemiology Program. “Subsequently, they may receive fewer immunizations and other child care and medical care services.”

The increased percentage of enrolled children in public insurance programs suggests that local outreach and enrollment efforts are having a positive effect. However, enrollment alone is not enough. Outreach efforts should focus on utilization of health services and retention of benefits in addition to enrollment, to help families maintain their coverage over time.

For a copy of the complete study on child insurance, visit: lapublichealth.org/ha. Health survey background: The Los Angeles County Health Survey is a periodic, population-based telephone survey that collects information on socio-demographic characteristics, health status, health behaviors and access to health services among adults and children in the County. The 2002- 03 survey collected information on a random sample of more than 8,000 adults and nearly 6,000 children with interviews offered in six languages.

Public Health is committed to protecting and improving the health of the nearly 10 million residents of Los Angeles County. Through a variety of programs, community partnerships and services, Public Health oversees environmental health, disease control and community and family health and comprises more than 4,000 employees with an annual budget exceeding $600 million.